Cath Labs Trying to Get Back on Track With Quality Measures, Documentation

ATLANTA, GA—The COVID-19 pandemic is far from over, but many cath labs are now facing the need to right their ships and take control of the damage done to internal quality-assurance processes and some patient outcomes over the last 2 years, new data suggest.

Among the quality metrics affected were random case reviews for quality purposes, monitoring of normal angiogram rates, and reporting reviews, said Bonnie Weiner, MD (Saint Vincent Hospital, Worcester, MA), who presented the results as a poster here at the Society for Cardiovascular Angiography and Interventions (SCAI) 2022 Scientific Sessions.

“Most of these centers have recognized that they have significant deterioration compared with the way they were doing their quality checks before the pandemic,” she told TCTMD. “We’re starting to see more facilities reemerging from the disruption of care and trying to get back on track.”

Weiner is chief medical officer of the Accreditation for Cardiovascular Excellence (ACE), an independent organization sponsored by SCAI and the American College of Cardiology (ACC) that reviews centers performing invasive cardiac and endovascular procedures, accrediting those that achieve predetermined benchmarks for quality care, and focuses on continuous quality improvement. For the study, ACE looked at six centers that had comprehensive prepandemic data for comparison. Randomly selected cases from each site and at each time point were reviewed, for a total of 328 PCI cases.

Whereas 93.3% of angiographic documentation met standards for completeness in the pre-COVID period, only 33.0% met those standards during the pandemic (P < 0.004). Similarly for procedural documentation, 73.3% met criteria pre-COVID versus none during the COVID period (P < 0.003).

Chart reviews showed that patient outcomes also were worse, with 30-day mortality rates at 15.4% during COVID versus 2.6% pre-COVID (P < 0.002), contrast-induced nephropathy climbing to 11.5% from 1.5% (P < 0.004), and 30-day repeat hospitalization jumping to 11.5% from 3.1% (P = 0.007). Case reviews revealed that more patients presented with chest pain (16.5% vs 6.2%; P < 0.0001) and dyspnea (5.7% vs 2.4%; P < 0.03) compared with the pre-COVID period. However, there also were far more failures to document any indication for PCI (11.9% vs 1.0%; P < 0.0001).

“People were so focused on the sick COVID patients, the ICU care, the nursing issues, and all the things that were going on early in the pandemic, and appropriately so, that some of these other things like proper documentation just got pushed away out of necessity,” Weiner said. “I don't think most of the hospitals realized how extensive those changes were and what impact they would have on outcomes.”

Weiner and colleagues say the outcomes data could reflect access or limitations at facilities, patient complexity, or less attention to quality and a disconnect between administration and operators. The challenge now, in this not-quite post-COVID world, is to recognize where the gaps are and work on strategies to reengage staff.

“They know what they did before, even though there has been turnover in both physicians and administrative staff. They know how to be successful again,” she said. But she noted that even as centers make it a point to resume their full quality-assurance initiatives, they are being hit with a nationwide contrast shortage that is curtailing elective cases yet again.

“I think the point is for them to try to get back on track in a world that isn’t quite back to normal, but hopefully will be soon,” Weiner said.